Patient-Centered Care

Healthcare Providers Continue to Adapt to Changing Care Environments

Having been forced to rapidly adopt remote work and telehealth, providers are figuring out how they’ll manage mobility from here.

Brad Grimes

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Brad is a contributor to FedTech. He’s covered technology since 1991, when he first got his start in the industry.

Last year, when the COVID-19 pandemic had North Mississippi Health Services in its grip, the healthcare provider and its network of rural hospitals and clinics faced a shortage. When the pandemic was at its worst, like many hospitals, the Tupelo, Miss.-based health system’s top need was nurses. Now, as NMHS assesses the lessons learned from a challenging year, mobile technology and telehealth solutions will be key to delivering care in the future.

“We’re looking at models, like virtual nursing, where we’d use technology independently of the COVID situation so that centrally located nurses could take care of more patients,” says Dr. Benton Kilman, chief medical informatics officer for NMHS, who served as the provider’s interim CIO in the early days of the pandemic. “We’re weeks away from being able to have a central hospital oversee advanced-practice clinicians at two other hospitals, thanks to mobile technology and telemedicine.”

Even before the pandemic, many healthcare providers were at various stages of a digital transformation featuring mobile technology strategies that reached beyond hospital walls. The pandemic forced them to accelerate efforts along two crucial pathways: enabling remote work for employees and offering telehealth services to patients. Based on what they’ve gone through in the past year, some are adjusting or expanding their mobile environments.

In addition to its hospitals, NMHS operates many community clinics in the region. When the pandemic began, the provider was three years into a nascent telehealth program, using Cisco Jabber and Amwell telemedicine carts distributed throughout the organization to make care more accessible. It was also less than a year into a full rollout of its Epic electronic health records system.

“Suddenly, we’ve got to give access to employees working from home, and patients aren’t coming to our clinics, so we need to reach them in new ways,” Kilman says. Because of the spotty broadband infrastructure in Northern Mississippi, even telehealth visits require patients to drive to a clinic to consult with a remote doctor.

Dr. Benton Kilman, chief medical informatics officer for North Mississippi Health Services

Before it could start addressing the challenges, Kilman says, NMHS had to upgrade the wired and wireless network infrastructure at its facilities, which it accomplished in only three months. Then it could start getting creative, enabling solutions that would even allow practitioners to visit hospital patients from home using a mobile device.

“This is an industry that was slowly but surely acknowledging the benefits of IT,” says Mutaz Shegewi, IDC’s research director for worldwide provider IT transformation strategies. “Then, in a very short window of opportunity, two years of digital transformation happened over a period of two months. It was very inspiring. Now, many are looking at what they’ve done and saying, ‘Let’s keep certain things in place; let’s maintain the benefits of our efforts.’”

Fine-Tuning for Remote Work

Indeed, different healthcare providers took different journeys to a point where they can be strategic in how they deploy mobility solutions and telehealth. Some were early adopters of enabling technology; others were forced to act quickly. In both cases, providers have learned what works best for their organizations and begun to fine-tune their mobility strategies.

St. John’s Health, a regional medical system based in Jackson, Wyo., had already adopted VMware Workspace ONE for remote access to applications, virtual desktop infrastructure services and unified endpoint management. Originally, St. John’s embraced Workspace ONE, in part, to tap a pool of back-office workers outside the Jackson area. Over the past year, the solution allowed the provider to rapidly deploy zero-client PCs to newly remote workers and provision hundreds of Apple iPad devices for telehealth services.

“The VDI solution is easier to support than 600 different devices,” says Roger Perkins, executive director of IT at St. John’s Health. “We’re now more of a one-stop shop, in that we can make updates and patch programs, test everything and then roll it out to all staff at the same time.”

But, while VDI supports widespread mobility, St. John’s Health learned that it is not a one-size-fits-all solution to the challenges of remote work. In many cases, a full-blown VDI session is not necessary, Perkins explains, so St. John’s has begun to make individual applications available through Workspace ONE.

“Now we’re able to push out applications directly,” Perkins says. “For example, a physician may not want to jump all the way into a virtual desktop to access our EMR. Now they’re able to jump into Workspace ONE, access their application and run it, and they don’t have to take a bunch of extra steps. We were trying to make their lives easier and more efficient, which also helps support our patients.”

Improving the Mobile User Experience

Sentara Healthcare, which operates 12 hospitals serving communities in Virginia, North Carolina and Ohio, increased the availability of Microsoft Windows Virtual Desktop in response to the pandemic, while also supporting workers who only needed secure, authenticated access to certain IT services. Sentara acquired and deployed thousands of managed laptops when the pandemic began, using BeyondTrust privileged access management and Cisco Duo multifactor authentication technology to secure all devices accessing its resources. Because the transition was rapid, Sentara erred on the side of extreme risk mitigation.

“Configuration management and standards are critical, so when the team set up virtualized desktops, they dug through every setting to determine what we were going to allow,” says Dan Bowden, CISO at Sentara Healthcare. “Are we going to allow people to print? If so, who, and is that an exception or a default? We had to be willing to dig through every setting to determine maximum protection.”

As Sentara begins transitioning to its new normal, Bowden says, it’s clear some employees will work remotely full time. Therefore, the provider is now also focusing on user experience across its mobile environment.

65%

The share of patients, by 2023, who will access care through a digital experience.

Source: IDC, “IDC FutureScape: Worldwide Health Industry 2021 Predictions,” October 2020

“We got great support throughout the organization for our low-tolerance approach, but now this isn’t just COVID response,” Bowden says. “For a percentage of our workforce, this mobility is now normal, so we’re re-examining our controls to make the remote work experience better.”

For NMHS, as much as it has focused on telehealth services to reach its rural population, the provider has also been evolving the way it offers employees remote access to IT resources. NMHS had already been trying to reduce the number of VPN connections it offered to mobile workers when the pandemic began, says Kilman. In keeping with that strategy, as more employees started working from home, NMHS began making applications available through Citrix Workspace and Citrix StoreFront. The goal was to enable easier remote access from a variety of mobile devices while establishing strong authentication, access control and secure remote access without a VPN client.

“Initially, some users had to wait a little while as we went through the process, but at the end of the day, we delivered a good product and people were able to continue their work,” Kilman says.

Photography by Kyle Carpenter; illustration by Mathisworks/Getty Images